Anemia
Guidelines
"How I treat"
- 2020: Gilreath & Rodgers How I treat cancer-associated anemia
- 2020: Shander et al. How I treat anemia in the perisurgical setting
Initial evaluation
May consist of:
- CBC with differential, MCV
- Basic metabolic panel (BMP)
- Liver function tests (LFTs)
- Reticulocyte count
- Iron, total iron binding capacity (TIBC), ferritin
- Vitamin B12 +/- methylmalonic acid & homocysteine
- Folic acid
- TSH
- Peripheral smear
- Clinical history, lifestyle factors (e.g. alcohol)
- Medications
GI bleeding or iron deficiency
- Stool occult blood
- EGD & colonoscopy
- Celiac (TTG IgA)
- H. pylori Ab, H. pylori stool antigen
Hemolysis?
- LDH
- Haptoglobin
- Direct & indirect Coombs
- LFTs (direct, indirect, total bilirubin)
- Infectious: anaplasma, babesia, ehrlichia
Anemia of chronic disease/anemia chronic kidney disease
- Basic metabolic panel (BMP) & iron labs as above
- Serum erythropoietin
- ESR
- CRP
Chronic/inherited?
- Hemoglobin electrophoresis
- Sickle cell evaluation
Myeloma?
- SPEP & IFE
- UPEP
- Free serum/urine kappa/lambda light chains
- Skeletal survey
Primary marrow process/hematologic malignancy
Less common
- Copper
- Zinc